妊娠早期BMI和25-(OH)D3在妊娠期糖尿病中交互作用及预测价值研究

doi:10.12280/gjfckx.20240421

摘要/Abstract

摘要：

目的：探讨体质量指数（body mass index，BMI）和25-羟维生素D₃[25-hydroxyvitamin D₃，25-(OH)D₃]在妊娠期糖尿病（gestational diabetes mellitus，GDM）中的交互作用及预测价值。方法：回顾性分析北京航天总医院2020年1月—2023年1月收治的102例GDM孕妇（GDM组）的临床资料，另选取同期102例健康孕妇作为对照组，比较2组妊娠早期（8~12周产检时）BMI、25-（OH）D₃水平、口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）时空腹血糖（fasting blood glucose，FBG）、餐后1 h血糖（1 h PBG）、餐后2 h血糖（2 h PBG）水平，评估BMI、25-（OH）D₃预测GDM的价值，并分析BMI、25-（OH）D₃在GDM中的交互作用。结果：GDM组OGTT时FBG、1 h PBG、2 h PBG及妊娠早期BMI水平高于对照组，GDM组妊娠早期25-（OH）D₃水平低于对照组（均P<0.05）。妊娠早期BMI与OGTT时FBG、1 h PBG、2 h PBG水平呈正相关，25-（OH）D₃与OGTT时FBG、1 h PBG、2 h PBG水平呈负相关（均P<0.001）。妊娠早期高BMI是GDM发生的独立危险因素（OR=1.285，95%CI：1.161~1.422，P<0.001）、高25-（OH）D₃是GDM发生的独立保护因素（OR=0.924，95%CI：0.899~0.948，P<0.001）；调整混杂因素后，妊娠早期BMI、25-（OH）D₃在GDM发生风险中呈正向交互作用，协同效应为二者单独存在产生效应之和的2.096倍（SI=2.096）。受试者工作特征（receiver operating characteristic，ROC）曲线分析显示，妊娠早期BMI和25-（OH）D₃联合预测GDM的曲线下面积（area under the curve，AUC）为0.832，敏感度为76.47%，特异度为75.49%。结论：妊娠早期高BMI水平与低25-（OH）D₃水平同时存在时GDM发生风险增加，可作为预测指标，为预防GDM提供指导信息。

关键词: 糖尿病, 妊娠, 人体质量指数, 骨化二醇, 妊娠初期, 预测, 交互关系

Abstract:

Objective: To investigate the interaction and predictive value of body mass index (BMI) and 25-hydroxyvitamin D₃ [25-(OH)D₃] in gestational diabetes mellitus (GDM). Methods: A retrospective analysis was conducted on the clinical data of 102 pregnant women with GDM (GDM group) admitted to Beijing Aerospace General Hospital from January 2020 to January 2023. Another 102 healthy pregnant women during the same period were selected as the control group. The BMI and 25-(OH)D₃ levels in early pregnancy (8-12 weeks gestation), as well as fasting blood glucose (FBG), 1-hour postprandial blood glucose (1 h PBG), 2-hour postprandial blood glucose (2 h PBG) levels during the oral glucose tolerance test (OGTT), were compared between the two groups. The predictive value of BMI and 25-(OH)D₃ in GDM was evaluated, the interaction between BMI and 25-(OH)D₃ in GDM was analyzed. Results: The GDM group had higher FBG, 1 h PBG, 2 h PBG, and early pregnancy BMI levels than the control group, while the early pregnancy 25-(OH)D₃ levels in the GDM group were lower than those in the control group (all P<0.05). Early pregnancy BMI was positively correlated with FBG, 1 h PBG, and 2 h PBG levels during OGTT, whereas 25-(OH)D₃ was negatively correlated with FBG, 1 h PBG, and 2 h PBG levels during OGTT (all P<0.001). High BMI in early pregnancy was an independent risk factor for GDM (OR=1.285, 95%CI: 1.161-1.422, P<0.001), while high 25-(OH)D₃ was an independent protective factor against GDM (OR=0.924, 95%CI: 0.899-0.948, P<0.001). After adjusting for confounding factors, a positive interaction between early pregnancy BMI and 25-(OH)D₃ was observed in the risk of GDM, with a synergistic effect that was 2.096 times the sum of their individual effects (SI=2.096). Receiver operating characteristic (ROC) curve analysis showed that the combined prediction of GDM using early pregnancy BMI and 25-(OH)D₃ have an area under the curve (AUC) of 0.832, with a sensitivity of 76.47% and a specificity of 75.49%. Conclusions: The simultaneous presence of high BMI and low 25-(OH)D₃ levels in early pregnancy increases the risk of GDM, which can serve as a predictive indicators to provide guidance for the preventing GDM.

Key words: Diabetes, gestational, Body mass index, Calcifediol, Pregnancy trimester, first, Forecasting, Interactive relationships

刘昭, 赵琳琳, 李霞, 王细先. 妊娠早期BMI和25-(OH)D₃在妊娠期糖尿病中交互作用及预测价值研究[J]. 国际妇产科学杂志, 2024, 51(5): 541-545.

LIU Zhao, ZHAO Lin-lin, LI Xia, WANG Xi-xian. Study on the Interaction and Predictive Value of Early Pregnancy BMI and 25-(OH)D₃ in Gestational Diabetes Mellitus[J]. Journal of International Obstetrics and Gynecology, 2024, 51(5): 541-545.

图/表 7

参考文献 20

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组别	n	年龄（岁）	孕次（次）	产次（次）	流产次数（次）	糖尿病家族史	吸烟史	酗酒史	不良孕产史
GDM组	102	28.73±2.65	2.82±0.63	1.15±0.32	1.15±0.16	33（32.35）	12（11.76）	18（17.65）	15（14.71）
对照组	102	28.34±2.41	2.76±0.51	1.13±0.31	1.12±0.17	31（30.39）	13（12.75）	16（15.69）	17（16.67）
t或χ²		1.100	0.748	0.453	1.298	0.091	0.046	0.141	0.148
P		0.273	0.456	0.651	0.196	0.763	0.831	0.707	0.700

组别	n	年龄（岁）	孕次（次）	产次（次）	流产次数（次）	糖尿病家族史	吸烟史	酗酒史	不良孕产史
GDM组	102	28.73±2.65	2.82±0.63	1.15±0.32	1.15±0.16	33（32.35）	12（11.76）	18（17.65）	15（14.71）
对照组	102	28.34±2.41	2.76±0.51	1.13±0.31	1.12±0.17	31（30.39）	13（12.75）	16（15.69）	17（16.67）
t或χ²		1.100	0.748	0.453	1.298	0.091	0.046	0.141	0.148
P		0.273	0.456	0.651	0.196	0.763	0.831	0.707	0.700

组别	n	FBG （mmol/L）	1 h PBG （mmol/L）	2 h PBG （mmol/L）	BMI （kg/m²）	25-(OH)D₃ （ng/mL）
GDM组	102	5.23±0.44	10.55±0.73	8.92±0.51	25.02±3.36	21.25±13.10
对照组	102	4.36±0.37	8.39±0.58	6.24±0.64	22.25±3.56	37.80±17.81
t		15.264	23.398	33.075	5.384	7.562
P		<0.001	<0.001	<0.001	<0.001	<0.001

组别	n	FBG （mmol/L）	1 h PBG （mmol/L）	2 h PBG （mmol/L）	BMI （kg/m²）	25-(OH)D₃ （ng/mL）
GDM组	102	5.23±0.44	10.55±0.73	8.92±0.51	25.02±3.36	21.25±13.10
对照组	102	4.36±0.37	8.39±0.58	6.24±0.64	22.25±3.56	37.80±17.81
t		15.264	23.398	33.075	5.384	7.562
P		<0.001	<0.001	<0.001	<0.001	<0.001

因素	β	S.E.	Wald χ²	OR	95%CI	P
BMI（kg/m²）	0.250	0.052	23.472	1.285	1.161~1.422	<0.001
25-(OH)D₃（ng/mL）	-0.080	0.014	34.217	0.924	0.899~0.948	<0.001

妊娠早期BMI和25-(OH)D₃在妊娠期糖尿病中交互作用及预测价值研究

Study on the Interaction and Predictive Value of Early Pregnancy BMI and 25-(OH)D₃ in Gestational Diabetes Mellitus

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BMI/ 25-(OH)D₃	对照组（n）	GDM组（n）	OR	95%CI	RERI	AP	SI
-/+	39	8	1.000	-	8.744	49.33%	2.096
-/-	28	34	5.920	1.992~8.204
+/+	24	20	4.063	1.356~7.825
+/-	11	40	17.727	7.943~27.617

指标	AUC	95%CI	P	截断值	敏感度（%）	特异度（%）
BMI（kg/m²）	0.701	0.631~0.771	<0.001	21.99	77.45	52.94
25-(OH)D₃（ng/mL）	0.770	0.707~0.832	<0.001	21.53	83.33	58.82
联合	0.832	0.778~0.886	<0.001	-	76.47	75.49

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